Discover NIMH Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Discover NIMH Survey Form
1 Discover NIMH survey Discover NIMH Survey_10.24.22.pdf Form
0925-0648 Template exp.6.2024_Discover NIMH Survey.docx fast track for NIMH Discover survey IC Document
Recruitment Materials_Discover NIMH Survey_10.24.22.docx email invitation IC Document

Information Collection (IC) Details

IC Title:	Discover NIMH Survey	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Discover NIMH survey	Discover NIMH Survey_10.24.22.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	417	417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
fast track for NIMH Discover survey	0925-0648 Template exp.6.2024_Discover NIMH Survey.docx	10/26/2022
email invitation	Recruitment Materials_Discover NIMH Survey_10.24.22.docx	10/26/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.